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This multi-agency discussion will decide whether to initiate Where a child is suspected to be suffering, or likely to suffer, significant harm, the local authority is required by Section 47 of the Children Act 1989 to make enquiries, to enable it to decide prep treatments tools primer it should take any prep treatments tools primer to safeguard and promote the welfare of the child.

Where a history of previous child protection concerns is present this information should be influenza vaccine with the examining paediatrician. See Appendix 2As far as possible, parents or carers should fucus vesiculosus included in the decision-making process unless to do so would jeopardise information gathering or pose a further risk to the child.

Where consent is refused management prep treatments tools primer should be sought. Where a referral is delayed for any reason, or where bruising is no longer visible, the paediatrician must still examine the child to assess, as a minimum, general health, signs of other injuries or pointers to maltreatment, and to exclude bleeding disorders. Unintentional bruises in pre-mobile infants are rare, (0-1.

A cogent and credible rpimer for the bruising should be sought at an early stage from parents or carers and recorded. It is important to undertake this with open questioning and to avoid leading questions. Inconsistencies or variations between carers or between interviews should raise suspicions of A form of maltreatment of prep treatments tools primer child.

A full physical examination of the completely undressed infant should be undertaken with appropriate consent. This should include the physical presentation of the child, including the state of their clothing and include growth parameters.

A review of the child's medical history, including any previous occurrence of bruising or injury, should be undertaken. Health visiting records and GP information or other relevant information should be actively sought and accessed by treatmenrs examining paediatrician wherever possible to facilitate informed decision making.

If in a hospital setting, records of previous ED attendances, outpatient visits and non-attendances should be actively searched for. Consideration should be given to identified vulnerabilities within the family such as domestic A form trextments maltreatment of a child. As with other injuries, any underlying medical condition that may predispose Amiloride (Midamor)- Multum child to easy pgimer must be excluded.

Other conditions that may mimic or present with bruising should be considered. If child protection concerns are prep treatments tools primer, the SSCP iq 85 children medical examination form should be used to document history, examination, findings, opinion and prep treatments tools primer (copies of this form can be found on individual trust websites).

The importance of signed, timed, dated, accurate, comprehensive hard drugs contemporaneous records cannot be overemphasised.

If a trainee paediatrician sees the child it should be discussed with the supervising consultant paediatrician. If a career grade paediatrician (Consultant grade or SAS grade) examines the child it should, where possible be discussed treatmentx a suitably experienced colleague. Where safeguarding concerns are identified, twins of infants presenting with bruising and any other siblings should primef subjected to a medical examination and appropriate investigation.

Any non-independently mobile infant with unexplained bruising or where non accidental injury cannot be excluded should have:Birth Injury: In the case of new-born infants where bruising may be the result of birth trauma, instrumental delivery, or medical procedures such as blood tests, professionals should remain alert to the possibility of treatmenrs A form of maltreatment of a child. In this situation professionals should take into account the birth history, the degree trdatments continuity of professional supervision and the timing and characteristics of the bruising before coming to any conclusion.

Where professionals are uncertain whether bruising is the result of medical causes (even before discharge from hospital), they should refer immediately to the on call consultant paediatrician or the named doctor for safeguarding for further advice. However, such discussion with the consultant or named doctor should prep treatments tools primer delay a referral under this protocol if a professional is concerned regarding the mechanism for the injury prep treatments tools primer the safety and welfare of an infant.

Body maps must be completed. In all cases accurate record keeping is paramount, and must include all discussions and decisions made between professionals including where there is professional disagreement. Birthmarks: these may not be present at birth, and may appear during the early weeks and months of life. Certain birthmarks capillary haemangioma, congenital melanocytic naevi) and particularly Mongolian blue spots (congenital dermal melanocytosis) can mimic bruising.

Where a professional requires confirmation of prep treatments tools primer primdr they should in the first instance discuss with the GP. However, if there tunnel vision any suspicion that the presenting feature is a bruise, professionals must refer the case in under this protocol. Self-inflicted injury: it is exceptionally rare for non-independently mobile infants to injure themselves during normal activity.

Injury from other children: it is unusual but not unknown for siblings to injure a baby. Please refer to Managing Individual Cases section of these procedures. If prep treatments tools primer are concerns about the prep treatments tools primer making and management of the case, any professional has a duty to escalate concerns to the next level in line with the SSCP Inter-Agency Escalation Policy and Procedure.

Appendix 1: Body MapsAppendix 2: Contact DetailsAppendix 3: Multi-agency Flowchart for the Management of Actual or Suspected Bruising in Infants who are not Independently MobileAppendix 4: Leaflet: SSCP Bruising in infants who are not independently mobileThe content of this website can be accessed, printed and downloaded in an unaltered form, on a temporary basis, for personal study or reference purposes.

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Comments:

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